Is it Sensory, Behavior, or Both?

Is it sensory or is it behavior? I get this question quite a bit in the clinic. Parents want to know if their child is just messing with them, or if they truly have a sensory processing issue.

About 75% of the time, Dad chimes in with, “He’s just trying to get away with something,” while Mom is certain that sensory techniques are the golden ticket.

My response? “It could be both.”

(And no, that answer is not meant to be a cop-out.)

More than once I’ve seen occupational therapists “ping ponging” a child back and forth with a psychologist over a child’s severe behaviors. OTs say, “It’s behavior!” Psychologists reply, “It’s sensory!” And they disagree until the parent’s head spins.

This sort of back and forth usually happens because neither the OT nor the psychologist sees their techniques working in isolation. And hey, when you have the pressure of a parent who wants to know when someone is going to help their child, it can be easy to pass the buck. Let’s just be friends, people, because there are many instances when we really need to work together.

A Sensory/Behavior Link

Yes, sometimes a child’s outburst is purely sensory related; and yes, sometimes it is simply a typical tantrum. But there are many instances when the line greys and one might feed into another. Allow me to give a few examples of how sensory processing difficulties can breed behaviors.

Imagine you are an infant with an oral sensory sensitivity. Every time you eat something you feel awful, want to gag, and can’t stand the textures mushing around in your mouth. At a young age, you have learned that food = pain.

Now, imagine that as you grow, or receive amazing OT intervention, you are able to handle more complex textures without gagging. However, every time a new food is introduced, you remember that whole food = pain thing and toss the food onto the floor in a screaming rage. Victory! You showed that oatmeal who’s boss.

A parent might see that outburst and think, “Oh no, her sensory sensitivities are still impacting her eating habits!” When in actuality it might be a behavior that developed due to previous sensory issues.

For another example, let’s say that you are receiving intervention for your child with sensory processing issues. Every time they have a meltdown, they get a big ol’ dose of attention from Mommy or Daddy as you direct them to calming sensory input.

The child may then learn that crying/screaming = attention from Mom and Dad. Therefore, even when sensory processing issues start to resolve, a child might save a few of those nasty outbursts just for their parents. In this situation a mother might come to me and say, “I think he might be sensitive to clothing, but he really only acts out about it around me.”

How to Tell the Two Apart

Behavior or sensory… isn’t that the million dollar question? Professionals discuss this topic in books, lecture about it in courses, or debate about it amongst each other. Some of the latest issues with the official Sensory Processing Disorder (SPD) diagnosis stem from the fact that many physicians call all of these symptoms “behaviors”, claiming that SPD is not necessarily a stand-alone diagnosis.

Regardless of everyone’s opinions, parents can become paralyzed in a meltdown moment as they fear disciplining their child for something sensory related. They often tell me that they worry that others will look at them as “bad parents” because they don’t know what to discipline and what to write off as sensory.

This is where I tell my parents to be incredibly attentive to the subtle signs from their child. With any behavior analysis, there is an “antecedent,” or something that happens before the behavior. This is where the parent has to look for the clues. What was the root cause of the outburst?

This is one of the reasons why I am a big fan of journaling for parents of children with sensory processing issues. You would be surprised by the trends that a parent notices in their child when it is all written down in front of them.

For example:

A parent sees that their child refuses to listen to them in the morning in order to get out the door in time for school.

The child sees sensory overload from a snowball effect of aversive sensory input in the mornings. The little brother flicking the lights on and off to wake him up… his favorite cereal replaced by some generic brand…the tag in his new sweater for picture day that is relentlessly scratchy.

It is in these subtle details that you might be able to better figure out your child’s behaviors.

Another clue to watch out for is when behavioral interventions simply don’t work. Say you start to take away your child’s favorite things because they refuse to sit still in their chair. “No Wii tonight!”… “Your X-box is gone forever!”… “Now you can’t watch TV until you are 35!”

The child with sensory processing issues is going to be sobbing because they’ve lost their privileges, but you know they’ll still be bouncing around in that chair. In this case the child’s nervous system is driving them to move around, and they can’t do much to override that feeling. So no matter how motivating the reward or punishment may be, they just can’t help it.

What is the Best Approach?

I have to say, I don’t enjoy it when a child is beating on me throughout a session and the parent comments, “Oh, he just needs a lot of sensory input today.” Uh, no. The child might crave that heavy proprioceptive input into his muscles and joints, or may very well have acted out because his sensory system was overloaded, but you also have to realize that aggression and behavior play a part as well.

So yes, if an occupational therapist has determined that your child has sensory processing issues, you have to consider that it is going to influence their behaviors. This is why I feel that an approach with both sensory and behavioral techniques is ideal.

In general, sensory strategies recommended by an OT are safe to try along with your behavior plan. Continuing to support the sensory systems is a vital part of your child’s everyday life, and actually a good way to “tease out” behaviors if you observe how the child responds to situations when you know that they are regulated.

One key point with a behavioral strategy: make sure that sensory input is never withheld as a punishment. Even though it looks like fun, those sensory diet activities are actually something the child needs in order to stay organized.

This is just one of the reasons to support a close relationship between behavioral and sensory approaches. I’ve even seen some professionals recommend that the parent not let the child swing, or withhold their fidgets until they calm down. For some children, that is asking the impossible.

Even when parents are meticulously looking for the clues and attempting to determine why their child acts out, it’s not always going to be cut and dry. This is one of those “easier said than done” situations. This is why I feel it is important to support both sides of the issue so that the child has the opportunity for a balanced, regulated life with the appropriate boundaries.

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0 thoughts on “Is it Sensory, Behavior, or Both?”

I couldn’t agree more with Carolyns statement. There are many children who are being overdiagnosed with ADD/ADHD and combining sensory processing disorders with them. Also the behavioral specialists are also quick to add that a student has sensory issues, when really is it their behavior, therefore they act out because they can’t control their behavior and appears more like sensory issues. I could go on and on about sensory, because there is so much out there. I feel kids do not move enough in their environment and are not exposed to situations back when I was younger. Therefore more and more kids are being diagnosed with sensory processing concerns.

Thank you, Carolyn, for your response, and thank you wonderful anonymous OT for this site!
I need this site because I do work in a public elementary school district of 11 schools K-8 as the only OTR, having switched from 20 years practice in acute/hospital/adult/geriatric settings to K-8 ESS four years ago. I LOVE what I do but I am climbing a steep learning curve which seems to never end.
Here is my personal view: I am sure that school-based OT services would thrive with interventions, especially regarding sensory processing difficulties, if it were not for the money involved to keep a team of therapists within a school district. Our endlessly helpful OT hearts cannot do what we have been trained to so (and are constantly training ourselves to do) if the workload exceeds the caseload. My average caseload fluctuates around 100 students, my workload averages 11 to 12 hours each day and six, often seven days a week. I cannot but function only as a facilitator between students and the teaching staff and, when there’s time left, the parents. I have to be contend with the fact that I can only facilitate, offer ideas, modeling and resources (to sites like this wonderful one) and learn as much as I can through cont ed courses, and that I am simply not able to do what I KNOW can be done or should be done.
Carolyn, go for it: take seminars, never stop asking questions, never stop questioning everything including your own practice, and just study and learn. That is the one wonderful aspect of occupational therapy and those of us who practice it, that we can never say that we know it all! HOWEVER, keeping frustration away is a daily, often hourly exercise, but we need to treat ourselves first of all as if WE were the person with ADHD, ADD or autistic features including sensory processing difficulties. Not setting expectations too high for ourselves to understand and know EVERYTHING but keeping them REALISTIC will help us be realistic also for our kids.
All the best to you, Carolyn 🙂

When I started so long ago in the schools we did not use sensory tech AT ALL. Now it is being used so often, by so many people and . that I sometimes I think that people think it is very simple and that they can be in charge to do it ( i.e. teachers wanting to make their own sensory diets. ) The psychologists are jumping on the band wagon, and use the “regulation” term all the time. They are starting to make Functional Behavior Plans ( a plan trying to determine why a kid is acting out) and putting in sensory suggestions, without even contacting or getting the OT s input. I sometimes fear that because we have shared so much of our profession, that they will not need us, because they don’t see or understand what we do. And in a way they are almost right. Range of motion is always the same. It seems that heavy work always calms. etc. etc. I want to learn how to take my practice to the next level. I want to learn how to really use sensory to help the kids, but I am not quite sure how either, other than if hyper ( offer self resistives, therapband on chairs , wiggle cushions, fidgets, heavy work). I and (it feels like so many others) know the basics. What can help the kids at a deeper level with sensory in the schools? Also the Ots where I work always state ( which is true) we don’t do clinical therapy in the schools. But these kids are so poor often, and their parents aren’t going to get them to get private therapy, so how do we use it to help them significantly? My hardest cases are: 1.) Hyper ADD kids with parents whom don’t want to medicate, it feels like sensory is a band aid. 2.) Emotionally disturbed kids who the school team diagnose on their own, without OT input, that they are a “sensory kid” – when I haven’t even met the kid yet 3.) Deeply autistic kids whom scream and cry, non verbal, whom don’t seem to want to be pulled into “the non autistic ” school world. They seem to want to be left alone to self stim out. OI Vey! Any suggestions? I still need a more simple mantra of what helps rule out sensory from behavior that I can wrap my head around. I feel like I don’t get it. I have to go see the kid who was blowing out, they want me to “solve it” with sensory, and I’m thinking, but people it could be trauma related, it could be mental health related, it could be a multitude of things. I do like your point of mixing in behavioral strategies with sensory strategies, but I feel kind of sad when the psychologists are asking for SI book information, like they can just by pass OT. These kids are tough. I want to help them. I agree with the point about don’t make the sensory a “reward” after the blow out so quick, because it can condition more negative behavior. Also everyone seems ga ga about zones of regulation. Another thing that I feel kind of gives away our profession to everyone else. I think of clinical therapy as changing the nervous system, but these kids need it in school too, and I don’t know yet how to do it. We don’t have swings. I am feeling kind of down tonight, like all I can offer sensory wise is band aids. I want to see real improvements. Any suggestions of how to learn to make bigger impacts using sensory in the schools? Thanks! I do hope this IS anonymous.

nice you for spending some time to explain this, I believe strongly to sort it out and take pleasure in learning more in this particular topic. Whenever you can, as you receive expertise, on earth do you mind adding to your xwlzndb website with increased information? as it is very helpful for my situation.

I agree that the goal of sensory treatment should be proactive in nature, but that is a hard concept to explain to parents. If things are going well at home, the tendency is to back off of sensory strategies, and the cycle begins again. This point should be emphasized when working with parents and teachers.

I would add another caveat, make sure that the sensory input is not rewarding the negative behavior. The concept would be to provide the input before severe negative behaviors happen. If that child is hitting other people, that is not the time to provide a sensory reward. That child will learn that anytime he acts aggressively he gets positive feedback. the child still needs a consequence to a behavior that is not appropriate.

Hi! I came across your post searching “sensory or behavior” as it is something I have heard the OT at the preschool I work at say a lot. As a behavior analyst, I love that you talked about antecedents and mentioned the possibility of the problem behavior being attention or because of the history of gagging when presented with new food! Along the same lines as Patricia, I would like to add that good behavior interventions should address the sensory issue as an automatic function and teach appropriate replacement behaviors. With your example of sitting in the chair, a behavior intervention should include a teaching program to learn how to sit still for longer amounts of time and one to teach the child to identify when s/he is wiggling or needs to get up and to ask to get up or another appropriate behavior to meet that need (as well as any necessary antecedent/environmental manipulations). Thanks for your post!

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